Persistently and falsely claiming someone under your care is in poor health is often referred to as Munchausen syndrome by proxy.
Munchausen syndrome refers to someone deliberately and persistently faking their physical or mental illness symptoms or magnifying signs or symptoms of an illness.
When the person shows this behavior toward someone else, like a child, it’s referred to as Munchausen syndrome by proxy.
Munchausen is characterized by deliberately falsifying or exaggerating mental or physical illness symptoms, often for no obvious gain.
Though no longer recognized with this name in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), it’s a formal mental health diagnosis. Its symptoms fall on the spectrum of factitious disorders.
The DSM-5 lists four types of factitious disorders:
- with mostly psychological symptoms: faking confusion, hallucinations, and disorganized speech
- with mostly physical symptoms: faking pain, indigestion, or paralysis
- with both psychological and physical symptoms
- not otherwise specified: factitious disorder by proxy
Factitious disorders fall under the umbrella of somatic symptoms and related disorders. These are conditions where a person persistently focuses on symptoms to the point that they experience intense distress and impairment.
Munchausen syndrome was named after Karl Friedrich Hieronymus,
In the DSM-5, Munchausen syndrome is a factitious disorder imposed on self. This is the intentional falsification of your own medical symptoms despite no external benefits.
Falsifying, causing, or exaggerating symptoms in someone else for no obvious gain refers to a factitious disorder imposed on another. For example, a mother who persistently claims their child is ill, even when she knows it isn’t true.
The exact prevalence of these conditions is unknown, but the DSM-5 estimates it at approximately 1% or less of the general population.
What does ‘by proxy’ mean?
“By proxy” means you’re acting with authority on behalf of another person.
If you’re their proxy, you’re in charge of making decisions for them.
The DSM-5 establishes these criteria to diagnose factitious disorder by proxy:
- falsely presenting or causing physical or mental health symptoms in someone else with the intent of deception
- authoritatively and falsely presenting another (adult, child, or pet) to others as physically or mentally impaired
- the deceptive behavior occurs even when there’s no obvious gain or benefit
- no other mental health condition can explain these behaviors
Once a health professional has established these criteria, the person demonstrating the deceptive behavior receives the diagnosis.
Munchausen syndrome can be a one-time episode but often presents intermittently and for extended periods.
For many people, this condition results in a lifetime of medical appointments and hospital stays characterized by deceptive interactions with medical professionals.
For example, a mother with Munchausen by proxy will take her child to numerous health professionals while exaggerating or making up various mental or physical symptoms. Some of these professionals might order medical tests and procedures to attempt to discover the cause of these unexplained symptoms.
Other common characteristics of factitious disorder imposed on another include:
- extensive but inconsistent medical history in the patient, perhaps with symptoms that don’t seem to correlate
- frequent cycles of reporting improvement and worsening of the symptoms
- tendency to evade questions and change providers when a health professional is exploring causes other than a diagnosable condition
- eagerness to have multiple medical examinations or procedures performed on the proxy
- intense emotional reactions when a health professional doesn’t provide or confirm a diagnosis
- development of new symptoms when test results don’t lead to a diagnosis
- a long list of medical visits and hospital stays
When deception is for personal gain
Pretending someone in your care has a medical condition for gaining money, fame, or notoriety isn’t the same as Munchausen syndrome by proxy.
When reward is involved, the DSM-5 classifies this behavior as malingering.
Unlike factitious disorders, where you or someone in your care become the focus of medical attention, malingering isn’t about receiving treatment but rather is for personal advantage.
Formally, the DSM-5 indicates factitious disorder refers specifically to the act of falsifying injury or illness. It doesn’t discuss this behavior’s intent, impact, or underlying motivation.
If you experience Munchausen syndrome by proxy, your goal or intention may not be to harm your child, even if your actions do.
The diagnosis suggests your intent is medical deception, and everything else is secondary to that, from the clinical perspective.
But regardless of the diagnostic criteria, these deceptive behaviors may fall under the standards for child abuse or maltreatment, particularly if the caregiver goes to great lengths to “prove” the child has symptoms of an illness.
Proving these symptoms may involve mistreatment to induce symptomatic reactions, like covering a child’s nose to induce respiratory discomfort or taking them out in the cold with no cover to cause a cold. These behaviors could cause great distress to the child and put their health and life in jeopardy.
The exact cause of Munchausen syndrome by proxy is unknown, but some commonalities have been found among those experiencing this disorder.
Deceptive behaviors typically emerge in early adulthood, often after hospital stays or illnesses.
Women, particularly those who have worked in the healthcare field, appear more likely to experience factitious disorders, according to research from 2016.
Due to the deceptive nature of Munchausen syndrome by proxy, it’s been challenging for experts and researchers to gain more accurate information related to causes and prevalence.
Treatment for Munchausen syndrome by proxy is case-specific.
Due to the secretive nature of factitious disorders, the ideal treatment path for these conditions remains understudied.
A 2008 review of treatment strategies found no medication, behavioral therapy, psychotherapy, or multidisciplinary approach that proved effective. Symptoms of Munchausen syndrome seem to reappear even when addressed at first.
For this reason, treatment approaches focus on the recovery of the proxy.
A 2020 review indicated that the most common outcome of Munchausen syndrome by proxy is separation or removing the child from the environment. But in at least 12% of the cases, the outcome was the victim’s death.
When it comes to treatment, the review found that in 22% of cases, people didn’t return for follow-up treatment visits. In fact, only 10% of people who received the diagnosis received ongoing treatment.
Munchausen syndrome by proxy is a mental health condition in which a person falsifies an illness on someone else. Formally, the disorder is called factitious disorder by proxy or imposed on another.
Munchausen syndrome by proxy is considered a form of child abuse and, on some occasions, may put a child’s life in jeopardy.
Because deception is at its core, diagnosis and treatment of this condition are often challenging.